Glycated albumin levels are higher in diabetes patients with diffuse coronary artery disease (CAD) than in those with non-diffuse CAD, and are associated with increased levels of adhesion molecules and inflammatory markers, which may explain the role of glycated albumin in the development of diffuse disease, say researchers.

Diffuse CAD is common in patients with diabetes and associated with poor clinical outcomes, but the mechanisms involved in diffuse atheroma development in these patients are unclear.

To address this issue and to identify markers that may be of value for detecting diffuse CAD, Wei Feng Shen (Rui Jin Hospital, Shanghai, China) and co-workers recruited 602 consecutive patients with CAD undergoing coronary angiography at Rui Jin Hospital.

A diagnosis of diffuse CAD required significant stenoses to be greater than 20 mm, multiple significant stenoses in the same artery, and significant narrowing involving the whole length of the coronary artery.

Patients were placed into four groups according to Type 2 diabetes status and presence or absence of diffuse CAD: 296 patients had non-diffuse CAD and no Type 2 diabetes, 138 had diffuse CAD and no diabetes, 78 had diabetes and non-diffuse CAD, and 90 patients had both diabetes and diffuse CAD.

Blood samples were collected for measurement of serum glycated albumin, adhesion molecules (intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1], E-selectin), endogenous secretory receptor of advanced glycation endproducts (esRAGE), and high sensitivity C-reactive protein (hsCRP).

Reporting in the journal Clinica Chimica Acta, the authors demonstrated significantly increased levels of glycated albumin and hsCRP, and decreased esRAGE concentrations, in patients with diabetes and diffuse CAD compared with those with non-diffuse CAD.

Serum hsCRP levels were significantly increased in patients with diffuse CAD compared with non-diffuse CAD regardless of diabetes status.

Serum levels of the adhesion molecules VCAM-1, ICAM-1 and E-selectin were consistently increased in patients with diabetes compared with those without, but only ICAM-1 levels were significantly higher in diabetic patients with diffuse lesions compared with those with non-diffuse lesions. Glycated albumin levels correlated significantly with E-selectin and ICAM-1.

In the patients with diabetes, multivariable regression analysis revealed that male gender, hypertension, glycated albumin, hsCRP and ICAM-1 were independently associated with diffuse CAD.

Based on their findings and other similar work reported in the literature, the authors hypothesize that high levels of glycation products such as glycated albumin and impaired vascular protection (reflected by increased levels of adhesion molecules and low esRAGE) contribute to diffuse lesion formation in diabetes by mechanisms including inflammation, oxidative stress and endothelial impairment.

They conclude that further prospective studies with larger sample size are needed to assess the clinical significance of levels of these markers.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Results from the GALIANT trial confirm that vildagliptin is as effective as rosiglitazone or pioglitazone at improving glycemic control in Type 2 diabetes patients when added to metformin therapy.

“Vildagliptin, a novel, orally active, potent and selective inhibitor of dipeptidyl peptidase 4, represents a new option for the control of Type 2 diabetes,” say Lawrence Blonde (Ochsner Medical Center, New Orleans, Los Angeles, USA) and colleagues.

Previous studies, as reported by MedWire News, have demonstrated that vildagliptin improves islet function and reduces glycated hemoglobin (HbA1c) both as a monotherapy and in combination with metformin.

In the GALIANT (GALvus In Addition to metformin versus? Tzd/metformin in lowering HbA1c) study, Blonde and team randomly assigned 1653 patients to vildagliptin 100 mg/day or a thiazolidinedione (either pioglitazone or rosiglitazone at a dose at the investigators discretion) for a period of 3 months.

All participants had inadequately controlled Type 2 diabetes and were taking a stable dose of metformin greater than or equal to 1000 mg/day at baseline, which they continued throughout the study.

The researchers found that the average reduction in HbA1c from baseline to study completion was 0.68% and 0.57% in the vildagliptin and thiazolidinedione groups, respectively, establishing non-inferiority of vildagliptin to thiazolidinediones for glycemic control.

Of note, vildagliptin add-on therapy had a more favorable effect on body weight than thiazolidinediones with an average reduction of 0.58 kg at 3 months compared with a mean gain of 0.33 kg in the patients treated with add-on pioglitazone or rosiglitazone.

Adverse events were mostly minor and the overall frequency did not differ significantly between groups at 39.5% for vildagliptin versus 36.3% for thiazolidinediones.

“This study suggests that data previously reported from longer controlled phase III studies translates to settings emulating routine primary care practice in the USA, with vildagliptin having a similar efficacy to thiazolidinediones as an add-on to metformin,” conclude the authors in the journal Diabetes, Obesity and Metabolism.

They add: “Longer term studies in a primary care setting would be valuable.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

MedWire Links
DPP-4 inhibitors remain viable option for add-on treatment
Vildagliptin as effective as metformin in elderly Type 2 diabetes patients
Vildagliptin has similar effect on HbA1c to rosiglitazone, but less side effects
Long-term glycemic control similar with vildagliptin or pioglitazone
Vildagliptin ‘promising’ adjunct to metformin

If you are diabetic, then your doctor, or dietitian, will have discussed the glycemic index, and how important it is to eat foods that are low in this listing.

The GFI is a measure of the effect that carbohydrates have on blood sugar levels. A carbohydrate food, which breaks down quickly during the process of digestion, releases glucose rapidly into the blood stream, has a high GI.

Low gi foods break down slowly, and release glucose slowly into the bloodstream. Whether you have diabetes, or not, foods with a low index score have important health benefits.

A Doctor at the University of Toronto developed the glycemic index of food, during research into the best diet for people with diabetes. Foods which are low on the scale are not only slower in the digestive system, but also take the load off the liver.

A lower glycemic response means the body needs less insulin. A food, which is seventy or more, is high in the list. You may be surprised to find that cereals like Rice Krispies, and Cornflakes were rated as high.

Between fifty-six and sixty-nine is considered medium, and fifty-five or less, is low. You will be equally surprised to find the index number of vodka, beer, and alcohol is low, but this is because there are no carbohydrates in vodka. Fruits and vegetables all have low ratings.

If you are diabetic and need to eat a low GI diet, then there is a good deal of information available on the Internet. There are many websites, which display a comprehensive food listing.

This is especially useful as some foods, for example carrots and rice, have a large range of values. This varies according to the way you prepare the food, and is also because of natural botanical differences. Another example is the musa paradisiaca (banana). Research has shown that the carbohydrate content of bananas depended on how ripe they were.

On one website I found a table to calculate values, and a free calorie chart. There were ideas for recipes for those times when you need to create something special, and even a shopping list. You can save a lot of time, and frequent visits these websites, by making a printed copy of the food list. You can then refer to this guide whenever you want.

The gi diet has been incorporated into some of the top weight loss diets, such as the South Beach, and Atkins. This is because when your body digests foods, which are low on the index ratings, you feel fuller for longer. This allows you to eat fewer calories without the hunger pangs.

Body builders also use knowledge of the GFI in a product called weight gainer 1200, to feed muscle.

Obesity is a major factor in diabetes, so it is interesting to note that when you add a food from the low index chart to your meal, it lowers the level of the whole meal. Additionally research has shown that a 1000-calorie low index diet facilitates greater weight loss in obese adults with high insulin secretions.

If you are still confused about all this, you may like to consider buying software, the GI diet meal planner. This software doesn’t show you how to calculate the values, but does it all for you.